scholarly journals Discriminatory Value of the Ascending Aorta Diameter in Suspected Acute Type A Aortic Dissection

2018 ◽  
Author(s):  
Dustin G. Mark ◽  
Justin A. Davis ◽  
Yun‐Yi Hung ◽  
David R. Vinson
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Ascending Aorta ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Aorta Diameter

scholarly journals Low arterial pressure on admission as a predictor of mortality in operated patients with type A aortic dissection

2011 ◽  
Vol 68 (5) ◽  
pp. 410-416 ◽  
Author(s):  
Katica Pavlovic ◽  
Nada Cemerlic-Adjic ◽  
Aleksandra Jovelic ◽  
Dalibor Somer
Keyword(s):  
Blood Pressure ◽  
Aortic Dissection ◽  
Arterial Hypertension ◽  
Type A ◽  
Left Ventricular ◽  
Ascending Aorta ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
History Of ◽  
Aorta Diameter

Background/Aim. Hypertension is a known predictor of proximal aortic dissection, but it is not commonly present in these patients on presentation. The associations between ascending aorta with left ventricular hypertrophy, cardiovascular risk factors and coronary atherosclerosis, and outcome of these patients are not fully elucidated. Methods. This retrospective study included 55 consecutive patients with acute type A aortic dissection treated surgically in our institution during the last 2 years. The diagnosis was based on imaging studies. Diameter of ascending aorta was measured with echocardiography. Results. The mean age of the patients was 55.4 ? 12.19 years, and 72.7% were men. A history of arterial hypertension was present in 76.4% of the patients. Maximal ascending aorta diameter was 4.09 ? 0.59 cm, while patients with frank aneurysm accounted for 5.5%. Systolic blood pressure on admission was < 150 mmHg in 58.2% of the patients. Diastolic blood pressure on admission was < 90 mmHg in 54.5% of the patients. Mean arterial pressure on admission was 104.9 ? 24.6 mmHg. No correlations were demonstrated between maximal ascending aorta diameter and diameter of the left ventricular wall, any obtained risk factor and with coronary artery atherosclerosis (p > 0.05). After six months 11 (20%) patients died, while intrahospital mortality was 72%. According to logistic regression analysis which included traditional risk factors, echo parameters, coronary artery disease and logistic euro scor, mean arterial blood pressure was the independent predictor of a six-month mortality [RR 0.956; CI (0.918-0.994 ); p = 0.024]. Conclusion. In our population the acute type A aortic dissection occurred rarely in the setting of frank ascending aortic aneurysms > 5.0 cm. The majority of patients had a history of arterial hypertension. A history of arterial hypertension was not associated with maximal ascending aorta diameter. Mean arterial blood pressure was the independent predictor of a six-months mortality.

Acute Type A Aortic Dissection Treated Using a Tubular Stent-Graft in the Ascending Aorta and a Multibranched Stent-Graft in the Aortic Arch

2016 ◽  
Vol 24 (1) ◽  
pp. 75-80 ◽  
Author(s):  
Tilo Kölbel ◽  
Christian Detter ◽  
Sebastian W. Carpenter ◽  
Fiona Rohlffs ◽  
Yskert von Kodolitsch ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Open Surgery ◽  
Type A ◽  
Ascending Aorta ◽  
Type I ◽  
Acute Type ◽  
Stent Grafts ◽  
Type A Aortic Dissection ◽  
Custom Made

Purpose: To describe the combined use of a tubular stent-graft for the ascending aorta and an inner-branched arch stent-graft for patients with acute type A aortic dissection. Technique: The technique to deploy these modular, custom-made stent-grafts is demonstrated in 2 patients with acute DeBakey type I aortic dissections and significant comorbidities precluding open surgery. Both emergent procedures were made possible by the availability of suitable devices manufactured for elective repair in other patients. After preliminary carotid-subclavian bypass, a long Lunderquist guidewire was introduced from the right femoral artery to the left ventricle for delivery of the Zenith Ascend and Zenith Branched Arch Endovascular Grafts under inflow occlusion. Bridging stent-grafts were delivered to the innominate and left common carotid arteries to connect to the 2 inner branches; the left subclavian artery was occluded. Both cases were technically successful and resulted in exclusion of the false lumen in the ascending aorta. The operating and fluoroscopy times did not exceed those of comparable elective procedures. The patients were rapidly extubated shortly after the procedure and without serious immediate complications. One patient survived 11 months with a satisfactory repair; the other succumbed to complications of recurrent pneumonia after 23 days. Conclusion: Endovascular treatment of patients with acute type A aortic dissection using a combination of tubular and branched stent-grafts in the ascending aorta is feasible and offers an alternative strategy to open surgery.

Acute Type A Aortic Dissection After TAVR in an Octogenarian With Ascending Aorta Aneurysm

2021 ◽  
Author(s):  
Helen Hashemi ◽  
Sahil Khera ◽  
Malcolm Anastasius ◽  
Ismail El-Hamamsy ◽  
Gilbert H.L. Tang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Ascending Aorta ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Aorta Aneurysm

scholarly journals Equations Estimating the Predissected Diameter of the Ascending Aorta for Acute Type A Aortic Dissection

2019 ◽  
Vol 108 (2) ◽  
pp. 481-490 ◽  
Author(s):  
Takashi Yamauchi ◽  
Hiroshi Takano ◽  
Toshiki Takahashi ◽  
Takafumi Masai ◽  
Masayuki Sakaki ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Ascending Aorta ◽  
Acute Type ◽  
Type A Aortic Dissection

scholarly journals The results of an entry-oriented strategy for acute type A aortic dissection in octogenarians: an 18-year experience

2020 ◽  
Vol 58 (5) ◽  
pp. 949-956
Author(s):  
Takashi Igarashi ◽  
Yoichi Sato ◽  
Hirono Satokawa ◽  
Shinya Takase ◽  
Hiroki Wakamatsu ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Predictive Factors ◽  
Postoperative Bleeding ◽  
Multivariable Analysis ◽  
Type A ◽  
Ascending Aorta ◽  
Hospital Death ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Direct Discharge

Abstract OBJECTIVES The aim of this study was to evaluate the 18-year results of emergency operations for acute type A aortic dissection, especially in octogenarians. METHODS We reviewed 199 patients who underwent surgical aortic repair of an acute type A aortic dissection from January 2001 to December 2018. If the primary entry existed in the ascending aorta, we limited the extent of the replacement to within the ascending aorta. We analysed the early and late outcomes and identified the predictive factors for in-hospital death and difficulty of direct discharge to home. RESULTS The hospital mortality was 16%. The causes of death were postoperative bleeding (n = 8, 4%), intestinal ischaemia (n = 6, 3%), respiratory failure (n = 5, 3%), systemic inflammatory response syndrome (n = 4, 2%), low output syndrome (n = 3, 2%), sudden death (n = 3, 2%), myonephrotic metabolic syndrome (n = 2, 1%) and stroke (n = 1, 1%). Multivariable analysis revealed that an estimated glomerular filtration rate &lt;30 (P = 0.006), malperfusion (P = 0.001), rupture (P &lt; 0.001) and cross-clamping time (P = 0.003) were independent predictive factors of in-hospital death. Age was not a significant factor for predicting in-hospital death. Ascending aorta replacement (P = 0.013), advanced age (P = 0.002) and prolonged extracorporeal circulation time (P = 0.009) were independent predictive factors of difficulty in direct discharge to home. In the late follow-up period, the 5-year survival and aortic event-free rates were 62.2% and 88.9% in octogenarians, respectively. CONCLUSIONS From the perspective of saving lives, the results of emergency surgery for octogenarians were acceptable. Avoiding the postoperative decline in activities of daily living in octogenarians is a consideration going forward.

scholarly journals Rapid and safe direct cannulation of the true lumen of the ascending aorta in acute type A aortic dissection

2007 ◽  
Vol 134 (1) ◽  
pp. 244-245 ◽  
Author(s):  
Heinz Jakob ◽  
Konstantinos Tsagakis ◽  
Andras Szabo ◽  
Ingo Wiese ◽  
Matthias Thielmann ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Ascending Aorta ◽  
Acute Type ◽  
True Lumen ◽  
Type A Aortic Dissection
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